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10
FEATURE
two medical officers working the night shift. Given the huge burden of
trauma that came through the door, especially during the weekends,
this often resulted in unmitigated chaos.
About 75% of the presentations were due to trauma. The ED doctors
worked very closely with a surgical trauma team and the intensive
care unit in managing these patients. Gunshot wounds, penetrating
stab wounds, motor vehicle accidents, pedestrian vehicle accidents and
burns were all common.
It was sad and somewhat exhausting dealing with so many kids with
significant burns from open fires or boiling water. I certainly learned
the importance of careful fluid and electrolyte management, and the
prevention of secondary infection.
Over the course of my time there I learned how to undertake a
trauma assessment and prioritise management decisions in patients
who were unstable and had multiple injuries. I saw a few patients with
crush syndrome due to significant skeletal muscle injury, including
one case that resulted from a community beating with a sjambok.
From a procedural point of view, I spent lots of time suturing wounds,
including one laceration on a man’s leg that went right down to the
bone. Thankfully I had the guidance of an ED doctor, a retired surgeon.
I sutured a few deep lip lacerations that were very fiddly because of all
the swelling. I had the opportunity to intubate a couple of patients, put
in a central line and lots of large gauge resuscitation lines, take ABGs
by femoral artery puncture and administer procedural sedation.
The well known mantra, ‘see one, do one, teach one,’ was put into
practice at Edendale but there was usually good support from medical
officers and consultants when required. After assessing a patient, I could
usually briefly run my management plan by another member of the team.
The ED also dealt with medical and general surgical patients and